Healthcare Provider Details

I. General information

NPI: 1891938460
Provider Name (Legal Business Name): GREGORY L LIVERS, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S 1100 E SUITE 201
SALT LAKE CITY UT
84102-1500
US

IV. Provider business mailing address

24 S 1100 E SUITE 201
SALT LAKE CITY UT
84102-1500
US

V. Phone/Fax

Practice location:
  • Phone: 801-478-0010
  • Fax: 801-363-1847
Mailing address:
  • Phone: 801-478-0010
  • Fax: 801-363-1847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5763903-1205
License Number StateUT

VIII. Authorized Official

Name: MR. GREGORY LAWRENCE LIVERS
Title or Position: PRESIDENT
Credential: MD
Phone: 801-478-0010